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NAHC Comments on CMS’ Proposed Pre-Claim Review Demonstration for Home Health Services to OMB

Posted on Wednesday, July 27, 2016 5:55 PM

NAHC submitted comments to the Office of Management and Budget (OMB) regarding the proposal from CMS to introduce a system of “pre-claim review” on all home health services in the following states:
• Illinois
• Florida
• Michigan
• Texas
• Massachusetts

NAHC explains that the proposed program “falls short of what it takes to be an effective program integrity tool sufficient to offset the down-side risks to Medicare beneficiaries and upstanding home health agencies,” and recommends that the proposal be withdrawn.

NAHC argues the following negative consequences of the proposed program:
• It is not sufficiently targeted to the fraud or abuse of concern
• It is not evidence-based with demonstrated return on investment
• It does not prevent fraud
• It is absent adequate legal authority
• It erects barriers to appropriate care access
• It would be excessively burdensome
• It fails to distinguish between fraud and unintentional noncompliance and would be highly likely to lead to a significant number of “innocent victims” through care delays, extended stays in high risk settings and wrongful rejections of authorization

To read NAHC’s full comments, click here.

Corridor Can Help!
If your agency is located in one of the demonstration states, or you just want to be prepared, Corridor offers a variety of services to help you navigate through the CMS requirements – including:
• Readiness Assessment
• Outsourced Services
• Documentation Review

Call Corridor today for help with pre-claim review! 1-866-263-3795

For the full article, click here.

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